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James E Mitchell - One of the best experts on this subject based on the ideXlab platform.
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temporal associations between affective instability and dysregulated eating behavior in Bulimia nervosa
Journal of Psychiatric Research, 2017Co-Authors: Laura A Berner, Ross D. Crosby, James E Mitchell, Scott G. Engel, Jason M. Lavender, Li Cao, Stephen A WonderlichAbstract:Prior research suggests that the construct of emotional instability may be salient to Bulimia nervosa (BN), but no study to date has used ecological momentary assessment (EMA) to examine its temporal association with binge eating and purging. In the current study, 133 women with DSM-IV BN used portable digital devices to provide multiple daily negative affect (NA) and positive affect (PA) ratings and record eating disorder behaviors over 2 weeks. Two state-of-the art indices quantified affective instability: probability of acute change (PAC), which represents the likelihood of extreme affective increases, and mean squared successive difference (MSSD), which represents average change over successive recordings. For extreme affective change, results revealed that on bulimic behavior days, extreme NA increases were less likely after bulimic behaviors than before them, and extreme increases in PA were more likely after bulimic behaviors than during the same time period on non-bulimic behavior days. However, average NA instability (i.e., MSSD) was (a) greater on bulimic behavior days than non-bulimic behavior days, (b) greater after bulimic behaviors than during the same time period on non-bulimic behavior days, and (c) greater after bulimic behaviors than before them. Results lend support to the notion that bulimic behaviors are negatively reinforcing (i.e., via post-behavior acute affective changes), but also indicate that these behaviors may exacerbate overall affective dysregulation. These findings may improve understanding of BN maintenance and inform the development of novel interventions or refinement of existing treatments.
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a randomized controlled comparison of integrative cognitive affective therapy icat and enhanced cognitive behavioral therapy cbt e for Bulimia nervosa
Psychological Medicine, 2014Co-Authors: Stephen A Wonderlich, Ross D. Crosby, James E Mitchell, Carol B Peterson, Marjorie H Klein, Tracey L Smith, Scott J CrowAbstract:Background The purpose of this investigation was to compare a new psychotherapy for Bulimia nervosa (BN), integrative cognitive-affective therapy (ICAT), with an established treatment, ‘enhanced’ cognitive-behavioral therapy (CBT-E). Method Eighty adults with symptoms of BN were randomized to ICAT or CBT-E for 21 sessions over 19 weeks. Bulimic symptoms, measured by the Eating Disorder Examination (EDE), were assessed at baseline, at the end of treatment (EOT) and at the 4-month follow-up. Treatment outcome, measured by binge eating frequency, purging frequency, global eating disorder severity, emotion regulation, self-oriented cognition, depression, anxiety and self-esteem, was determined using generalized estimating equations (GEEs), logistic regression and a general linear model (intent-to-treat). Results Both treatments were associated with significant improvement in bulimic symptoms and in all measures of outcome, and no statistically significant differences were observed between the two conditions at EOT or follow-up. Intent-to-treat abstinence rates for ICAT (37.5% at EOT, 32.5% at follow-up) and CBT-E (22.5% at both EOT and follow-up) were not significantly different. Conclusions ICAT was associated with significant improvements in bulimic and associated symptoms that did not differ from those obtained with CBT-E. This initial randomized controlled trial of a new individual psychotherapy for BN suggests that targeting emotion and self-oriented cognition in the context of nutritional rehabilitation may be efficacious and worthy of further study.
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ecological momentary assessment of stressful events and negative affect in Bulimia nervosa
Journal of Consulting and Clinical Psychology, 2014Co-Authors: Andrea B Goldschmidt, Ross D. Crosby, Stephen A Wonderlich, Scott J Crow, Scott G. Engel, Jason M. Lavender, Carol B Peterson, James E MitchellAbstract:OBJECTIVE: Negative affect precedes binge eating and purging in Bulimia nervosa (BN), but little is known about factors that precipitate negative affect in relation to these behaviors. We aimed to assess the temporal relation among stressful events, negative affect, and bulimic events in the natural environment using ecological momentary assessment. METHOD: A total of 133 women with current BN recorded their mood, eating behavior, and the occurrence of stressful events every day for 2 weeks. Multilevel structural equation mediation models evaluated the relations among Time 1 stress measures (i.e., interpersonal stressors, work/environment stressors, general daily hassles, and stress appraisal), Time 2 negative affect, and Time 2 binge eating and purging, controlling for Time 1 negative affect. RESULTS: Increases in negative affect from Time 1 to Time 2 significantly mediated the relations between Time 1 interpersonal stressors, work/environment stressors, general daily hassles, and stress appraisal and Time 2 binge eating and purging. When modeled simultaneously, confidence intervals for interpersonal stressors, general daily hassles, and stress appraisal did not overlap, suggesting that each had a distinct impact on negative affect in relation to binge eating and purging. CONCLUSIONS: Our findings indicate that stress precedes the occurrence of bulimic behaviors and that increases in negative affect following stressful events mediate this relation. Results suggest that stress and subsequent negative affect may function as maintenance factors for bulimic behaviors and should be targeted in treatment.
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emotional states preceding and following acts of non suicidal self injury in Bulimia nervosa patients
Behaviour Research and Therapy, 2009Co-Authors: Jennifer J Muehlenkamp, Ross D. Crosby, Stephen A Wonderlich, Scott G. Engel, Andrea Wadeson, Heather Simonich, James E MitchellAbstract:Bulimia nervosa and non-suicidal self-injury (NSSI) co-occur at high rates, and both have been conceptualized as maladaptive emotion regulation strategies. Treatments focusing on emotion regulation have been designed for both problem behaviors, yet, there exists very little research examining the temporal emotional states surrounding acts of NSSI. Using ecological momentary assessment (EMA) methodology, the current study examined the temporal association between positive and negative emotional states prior to and consequent to acts of NSSI within a subset of Bulimia nervosa patients. Results indicate significant increases in negative affect, and decreases in positive affect, prior to an NSSI act. Post-NSSI, positive affect significantly increased while negative affect remained unchanged. The findings offer partial support for an emotion regulation paradigm to understanding NSSI within bulimic populations and implications for treatment are discussed.
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personality subtyping and Bulimia nervosa psychopathological and genetic correlates
Psychological Medicine, 2005Co-Authors: Stephen A Wonderlich, Ross D. Crosby, Scott J Crow, James E Mitchell, Thomas E Joiner, Daniel Le Grange, Carol B Peterson, Anna M Bardonecone, Marjorie H Klein, Howard SteigerAbstract:Background. There is empirical evidence suggesting that individuals with Bulimia nervosa vary considerably in terms of psychiatric co-morbidity and personality functioning. In this study, latent profile analysis was used to attempt to identify clusters of bulimic subjects based on psychiatric co-morbidity and personality. Method. A total of 178 women with Bulimia nervosa or a subclinical variant of Bulimia nervosa completed a series of self-report inventories of co-morbid psychopathology and personality, and also provided a buccal smear sample for genetic analyses. Results. Three clusters of bulimic women were identified : an affective-perfectionistic cluster, an impulsive cluster, and a low co-morbid psychopathology cluster. The clusters showed expected differences on external validation tests with both personality and eating-disorder measures. The impulsive cluster showed the highest elevations on dissocial behavior and the lowest scores on compulsivity, while the affective-perfectionistic cluster showed the highest levels of eating-disorder symptoms. The clusters did not differ on genetic variations of the serotonin transporter gene. Conclusions. This study corroborates previous findings suggesting that the Bulimia nervosa diag- nostic category is comprised of three classes of individuals based on co-morbid psychopathology and personality. These differences may have significant etiological and treatment implications.
Eric Stice - One of the best experts on this subject based on the ideXlab platform.
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reciprocal relations between rumination and bulimic substance abuse and depressive symptoms in female adolescents
Journal of Abnormal Psychology, 2007Co-Authors: Susan Nolenhoeksema, Eric Stice, Emily Wade, Cara BohonAbstract:The authors examined the reciprocal relations between rumination and symptoms of depression, Bulimia, and substance abuse with longitudinal data from 496 female adolescents. Rumination predicted future increases in bulimic and substance abuse symptoms, as well as onset of major depression, binge eating, and substance abuse. Depressive and bulimic, but not substance abuse, symptoms predicted increases in rumination. Rumination did not predict increases in externalizing symptoms, providing evidence for the specificity of effects of rumination, although externalizing symptoms predicted future increases in rumination. Results suggest rumination may contribute to the etiology of depressive, bulimic, and substance abuse pathology and that the former two disturbances may foster increased rumination. Results imply that it might be beneficial for prevention programs to target this cognitive vulnerability.
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a prospective test of the dual pathway model of bulimic pathology mediating effects of dieting and negative affect
Journal of Abnormal Psychology, 2001Co-Authors: Eric SticeAbstract:Because there have been few longitudinal investigations of integrative etiological theories of Bulimia nervosa, this study prospectively tested the dual-pathway model using random regression growth curve models and data from a 3-wave community sample of adolescent girls (N = 231). Initial pressure to be thin and thin-ideal internalization predicted subsequent growth in body dissatisfaction, initial body dissatisfaction predicted growth in dieting and negative affect, and initial dieting and negative affect predicted growth in bulimic symptoms. There was prospective evidence for most of the hypothesized mediational effects. Results are consistent with the assertion that pressure to be thin, thin-ideal internalization, body dissatisfaction, dieting, and negative affect are risk factors for bulimic pathology and provide support for the dual-pathway model.
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subtyping bulimic women along dietary restraint and negative affect dimensions
Journal of Consulting and Clinical Psychology, 1999Co-Authors: Eric Stice, Stewart W AgrasAbstract:: Etiologic models of Bulimia center on dieting and negative affect, yet no research has subtyped bulimic individuals according to whether they fit dietary versus negative affect profiles. This study subtyped 265 bulimic women along dieting and depressive dimensions and tested whether subtypes showed differences in eating pathology, clinical correlates, and treatment response. Cluster analysis revealed a pure dietary subtype (62%) and a mixed dietary-depressive subtype (38%). Whereas dietary and dietary-depressive bulimic women showed similar levels of bulimic behaviors, the latter reported more eating and weight obsessions; social maladjustment; higher rates of mood, anxiety, eating, impulse control, and personality disorders; and poorer treatment response. Results suggest dieting is a central feature of Bulimia, but depressive affect occurs in only a subset of cases. However, the combination of dieting and depressive affect seems to signal a more severe variant of Bulimia.
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dual pathway model of Bulimia nervosa longitudinal support for dietary restraint and affect regulation mechanisms
Journal of Social and Clinical Psychology, 1998Co-Authors: Eric Stice, Heather Shaw, Carol NemeroffAbstract:Although numerous risk factors for Bulimia nervosa have been identified, no multivariate models of Bulimia have been empirically investigated with longitudinal data. The current study provided a confirmatory test of the dual pathway model of Bulimia nervosa using prospective data from a community sample of adolescents (N = 218). Latent variable modeling indicated that negative affect and dietary restraint predicted future bulimic symptomatology. Further, these two factors mediated the effects of initial perceived pressure for a thin body, body mass, ideal body internalization, and body dissatisfaction on subsequent bulimic pathology. These findings provide additional support for the dual pathway model of Bulimia, suggest variables that might be targeted in prevention and treatment efforts, and point to several directions for future research.
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test of the dual pathway model of Bulimia nervosa evidence for dietary restraint and affect regulation mechanisms
Journal of Social and Clinical Psychology, 1996Co-Authors: Eric Stice, Carol Nemeroff, Heather ShawAbstract:Although sociocultural pressures are thought to contribute to Bulimia nervosa, little research has examined the mechanisms by which these factors might actually produce eating pathology. The present study tested an integrative model of Bulimia that centers around dietary restraint and affect regulation pathways. It also incorporates perceived sociocultural pressure, body-mass, ideal-body internalization, and body dissatisfaction. Using data from 257 female undergraduates, structural equation modeling revealed that the model accounted for 71% of the variance in bulimic symptomatology. The relation between perceived sociocultural pressure and bulimic symptoms was mediated by ideal-body internalization, body dissatisfaction, dietary restraint, and negative affect. The results support the dual pathway model of Bulimia and suggest variables that might be targeted in prevention efforts.
Stephen A Wonderlich - One of the best experts on this subject based on the ideXlab platform.
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dimensional analysis of emotion trajectories before and after disordered eating behaviors in a sample of women with Bulimia nervosa
Psychiatry Research-neuroimaging, 2018Co-Authors: Kendra R Becker, Sarah Fischer, Ross D. Crosby, Scott G. Engel, Stephen A WonderlichAbstract:Abstract There is an established relationship between increases in negative affect and engagement in binge eating and purging behaviors. Some evidence suggests that these behaviors may also be maintained via subsequent increases in positive affect. However, negative and positive affect are broad terms encompassing many emotions, and there is a theoretical speculation that every emotion consists of at least of three separate dimensions: valence, arousal, and approach/withdrawal. We conducted secondary analyses on a previously collected dataset using ecological momentary assessment in 133 women with Bulimia nervosa. Participants rated their experience of discrete emotions and bulimic behaviors six times per day. Negative and positive emotions were organized within the 3-dimensional space characterized by valence, arousal, and approach/withdrawal. With multilevel modeling, we examined the trajectories of dimensionally defined emotion constructs prior and subsequent to bulimic behaviors as well as on days with and without bulimic behaviors. Negative valence, high arousal, and avoidance typified emotions that reached the highest levels before bulimic behaviors and were at the highest mean levels on days with bulimic behaviors. Arousal did not appear to moderate the trajectories of positive emotions. Application of a dimensional understanding of emotions may help elucidate the complex relationship between mood and disordered eating.
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temporal associations between affective instability and dysregulated eating behavior in Bulimia nervosa
Journal of Psychiatric Research, 2017Co-Authors: Laura A Berner, Ross D. Crosby, James E Mitchell, Scott G. Engel, Jason M. Lavender, Li Cao, Stephen A WonderlichAbstract:Prior research suggests that the construct of emotional instability may be salient to Bulimia nervosa (BN), but no study to date has used ecological momentary assessment (EMA) to examine its temporal association with binge eating and purging. In the current study, 133 women with DSM-IV BN used portable digital devices to provide multiple daily negative affect (NA) and positive affect (PA) ratings and record eating disorder behaviors over 2 weeks. Two state-of-the art indices quantified affective instability: probability of acute change (PAC), which represents the likelihood of extreme affective increases, and mean squared successive difference (MSSD), which represents average change over successive recordings. For extreme affective change, results revealed that on bulimic behavior days, extreme NA increases were less likely after bulimic behaviors than before them, and extreme increases in PA were more likely after bulimic behaviors than during the same time period on non-bulimic behavior days. However, average NA instability (i.e., MSSD) was (a) greater on bulimic behavior days than non-bulimic behavior days, (b) greater after bulimic behaviors than during the same time period on non-bulimic behavior days, and (c) greater after bulimic behaviors than before them. Results lend support to the notion that bulimic behaviors are negatively reinforcing (i.e., via post-behavior acute affective changes), but also indicate that these behaviors may exacerbate overall affective dysregulation. These findings may improve understanding of BN maintenance and inform the development of novel interventions or refinement of existing treatments.
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a randomized controlled comparison of integrative cognitive affective therapy icat and enhanced cognitive behavioral therapy cbt e for Bulimia nervosa
Psychological Medicine, 2014Co-Authors: Stephen A Wonderlich, Ross D. Crosby, James E Mitchell, Carol B Peterson, Marjorie H Klein, Tracey L Smith, Scott J CrowAbstract:Background The purpose of this investigation was to compare a new psychotherapy for Bulimia nervosa (BN), integrative cognitive-affective therapy (ICAT), with an established treatment, ‘enhanced’ cognitive-behavioral therapy (CBT-E). Method Eighty adults with symptoms of BN were randomized to ICAT or CBT-E for 21 sessions over 19 weeks. Bulimic symptoms, measured by the Eating Disorder Examination (EDE), were assessed at baseline, at the end of treatment (EOT) and at the 4-month follow-up. Treatment outcome, measured by binge eating frequency, purging frequency, global eating disorder severity, emotion regulation, self-oriented cognition, depression, anxiety and self-esteem, was determined using generalized estimating equations (GEEs), logistic regression and a general linear model (intent-to-treat). Results Both treatments were associated with significant improvement in bulimic symptoms and in all measures of outcome, and no statistically significant differences were observed between the two conditions at EOT or follow-up. Intent-to-treat abstinence rates for ICAT (37.5% at EOT, 32.5% at follow-up) and CBT-E (22.5% at both EOT and follow-up) were not significantly different. Conclusions ICAT was associated with significant improvements in bulimic and associated symptoms that did not differ from those obtained with CBT-E. This initial randomized controlled trial of a new individual psychotherapy for BN suggests that targeting emotion and self-oriented cognition in the context of nutritional rehabilitation may be efficacious and worthy of further study.
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ecological momentary assessment of stressful events and negative affect in Bulimia nervosa
Journal of Consulting and Clinical Psychology, 2014Co-Authors: Andrea B Goldschmidt, Ross D. Crosby, Stephen A Wonderlich, Scott J Crow, Scott G. Engel, Jason M. Lavender, Carol B Peterson, James E MitchellAbstract:OBJECTIVE: Negative affect precedes binge eating and purging in Bulimia nervosa (BN), but little is known about factors that precipitate negative affect in relation to these behaviors. We aimed to assess the temporal relation among stressful events, negative affect, and bulimic events in the natural environment using ecological momentary assessment. METHOD: A total of 133 women with current BN recorded their mood, eating behavior, and the occurrence of stressful events every day for 2 weeks. Multilevel structural equation mediation models evaluated the relations among Time 1 stress measures (i.e., interpersonal stressors, work/environment stressors, general daily hassles, and stress appraisal), Time 2 negative affect, and Time 2 binge eating and purging, controlling for Time 1 negative affect. RESULTS: Increases in negative affect from Time 1 to Time 2 significantly mediated the relations between Time 1 interpersonal stressors, work/environment stressors, general daily hassles, and stress appraisal and Time 2 binge eating and purging. When modeled simultaneously, confidence intervals for interpersonal stressors, general daily hassles, and stress appraisal did not overlap, suggesting that each had a distinct impact on negative affect in relation to binge eating and purging. CONCLUSIONS: Our findings indicate that stress precedes the occurrence of bulimic behaviors and that increases in negative affect following stressful events mediate this relation. Results suggest that stress and subsequent negative affect may function as maintenance factors for bulimic behaviors and should be targeted in treatment.
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momentary emotion surrounding bulimic behaviors in women with Bulimia nervosa and borderline personality disorder
Journal of Psychiatric Research, 2012Co-Authors: Edward A Selby, Ross D. Crosby, Stephen A Wonderlich, Scott G. Engel, Peter Doyle, James Mitchell, Daniel Le GrangeAbstract:Abstract Background Bulimia nervosa (BN) and borderline personality disorder (BPD) are disorders that involve emotion dysregulation, for negative emotion in particular, as well as impulsive behaviors beyond binge eating and vomiting. Given these similarities in psychopathology, it is not surprising that those with BN also present with BPD in approximately one third of cases. Improved understanding of similarities and differences in the experience of negative and positive emotion could aid in the development of treatments specifically tailored to the needs of these disorders. Methods In this study, we examined Ecological Momentary Assessment (EMA) data from 133 women diagnosed with BN, 25 of whom also exhibited diagnostic levels of BPD. Emotions and behaviors were assessed daily, with multiple random and event-contingent signals to complete questionnaires on portable digital devices, for a period of two weeks. Results Results indicated that the BPD group experienced higher negative emotional variability on bulimic event days. Both groups also demonstrated increasing negative emotion and decreasing positive emotion pre- binge eating and vomiting, with levels of negative emotion decreasing and positive emotion increasing after, for both behaviors. Conclusions In terms of group differences, additive effects were found for the BN comorbid with BPD group, who demonstrated greater negative emotional variability, on bulimic event days, and also had higher overall levels of negative emotion pre- and post-binge eating. Those with BN only, however, displayed increasing trajectories of positive emotion before and after binge eating and after vomiting, indicating a potential emotional dampening effect of BPD.
Scott J Crow - One of the best experts on this subject based on the ideXlab platform.
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examining the roles of emotion dysregulation and impulsivity in the relationship between psychological trauma and substance abuse among women with bulimic spectrum pathology
Eating Disorders, 2021Co-Authors: Lauren M Schaefer, Ross D. Crosby, Scott J Crow, Carol B Peterson, Vivienne M Hazzard, Kathryn E Smith, Cassandra A Johnson, Li Cao, Anna M BardoneconeAbstract:Individuals with Bulimia nervosa report elevated rates of childhood maltreatment, which appears to increase risk for co-occurring substance use problems and negatively impact clinical course. The current study sought to examine the mechanistic pathways by which specific forms of childhood maltreatment may give rise to substance use problems among individuals with bulimic-spectrum pathology. Women with bulimic-spectrum disorders (N = 204) completed measures of childhood trauma, emotion dysregulation, impulsivity, and substance use. Path analysis was used to examine emotion dysregulation and impulsivity as mediators of the relationship between distinct forms of childhood trauma (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse) and the presence of problematic alcohol/drug use. In the full path model, significant pathways from childhood emotional abuse to emotion dysregulation, childhood emotional neglect to impulsivity, and emotion dysregulation to problematic substance use emerged. Further, emotion dysregulation significantly mediated the relationship between emotional abuse and substance use. Results indicate that emotion dysregulation may be an important mechanism linking a history of childhood emotional maltreatment to later eating and substance use problems, and therefore may be an important treatment target among individuals with co-occurring eating and substance use concerns.Childhood emotional abuse was related to greater emotion dysregulation.Childhood emotional neglect was related to greater impulsivity.Emotion dysregulation was related to greater problematic substance use.Emotional abuse may impact substance use through emotion dysregulation.Creating emotion dysregulation may improve substance and eating disorder symptoms.
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a randomized controlled comparison of integrative cognitive affective therapy icat and enhanced cognitive behavioral therapy cbt e for Bulimia nervosa
Psychological Medicine, 2014Co-Authors: Stephen A Wonderlich, Ross D. Crosby, James E Mitchell, Carol B Peterson, Marjorie H Klein, Tracey L Smith, Scott J CrowAbstract:Background The purpose of this investigation was to compare a new psychotherapy for Bulimia nervosa (BN), integrative cognitive-affective therapy (ICAT), with an established treatment, ‘enhanced’ cognitive-behavioral therapy (CBT-E). Method Eighty adults with symptoms of BN were randomized to ICAT or CBT-E for 21 sessions over 19 weeks. Bulimic symptoms, measured by the Eating Disorder Examination (EDE), were assessed at baseline, at the end of treatment (EOT) and at the 4-month follow-up. Treatment outcome, measured by binge eating frequency, purging frequency, global eating disorder severity, emotion regulation, self-oriented cognition, depression, anxiety and self-esteem, was determined using generalized estimating equations (GEEs), logistic regression and a general linear model (intent-to-treat). Results Both treatments were associated with significant improvement in bulimic symptoms and in all measures of outcome, and no statistically significant differences were observed between the two conditions at EOT or follow-up. Intent-to-treat abstinence rates for ICAT (37.5% at EOT, 32.5% at follow-up) and CBT-E (22.5% at both EOT and follow-up) were not significantly different. Conclusions ICAT was associated with significant improvements in bulimic and associated symptoms that did not differ from those obtained with CBT-E. This initial randomized controlled trial of a new individual psychotherapy for BN suggests that targeting emotion and self-oriented cognition in the context of nutritional rehabilitation may be efficacious and worthy of further study.
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ecological momentary assessment of stressful events and negative affect in Bulimia nervosa
Journal of Consulting and Clinical Psychology, 2014Co-Authors: Andrea B Goldschmidt, Ross D. Crosby, Stephen A Wonderlich, Scott J Crow, Scott G. Engel, Jason M. Lavender, Carol B Peterson, James E MitchellAbstract:OBJECTIVE: Negative affect precedes binge eating and purging in Bulimia nervosa (BN), but little is known about factors that precipitate negative affect in relation to these behaviors. We aimed to assess the temporal relation among stressful events, negative affect, and bulimic events in the natural environment using ecological momentary assessment. METHOD: A total of 133 women with current BN recorded their mood, eating behavior, and the occurrence of stressful events every day for 2 weeks. Multilevel structural equation mediation models evaluated the relations among Time 1 stress measures (i.e., interpersonal stressors, work/environment stressors, general daily hassles, and stress appraisal), Time 2 negative affect, and Time 2 binge eating and purging, controlling for Time 1 negative affect. RESULTS: Increases in negative affect from Time 1 to Time 2 significantly mediated the relations between Time 1 interpersonal stressors, work/environment stressors, general daily hassles, and stress appraisal and Time 2 binge eating and purging. When modeled simultaneously, confidence intervals for interpersonal stressors, general daily hassles, and stress appraisal did not overlap, suggesting that each had a distinct impact on negative affect in relation to binge eating and purging. CONCLUSIONS: Our findings indicate that stress precedes the occurrence of bulimic behaviors and that increases in negative affect following stressful events mediate this relation. Results suggest that stress and subsequent negative affect may function as maintenance factors for bulimic behaviors and should be targeted in treatment.
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personality subtyping and Bulimia nervosa psychopathological and genetic correlates
Psychological Medicine, 2005Co-Authors: Stephen A Wonderlich, Ross D. Crosby, Scott J Crow, James E Mitchell, Thomas E Joiner, Daniel Le Grange, Carol B Peterson, Anna M Bardonecone, Marjorie H Klein, Howard SteigerAbstract:Background. There is empirical evidence suggesting that individuals with Bulimia nervosa vary considerably in terms of psychiatric co-morbidity and personality functioning. In this study, latent profile analysis was used to attempt to identify clusters of bulimic subjects based on psychiatric co-morbidity and personality. Method. A total of 178 women with Bulimia nervosa or a subclinical variant of Bulimia nervosa completed a series of self-report inventories of co-morbid psychopathology and personality, and also provided a buccal smear sample for genetic analyses. Results. Three clusters of bulimic women were identified : an affective-perfectionistic cluster, an impulsive cluster, and a low co-morbid psychopathology cluster. The clusters showed expected differences on external validation tests with both personality and eating-disorder measures. The impulsive cluster showed the highest elevations on dissocial behavior and the lowest scores on compulsivity, while the affective-perfectionistic cluster showed the highest levels of eating-disorder symptoms. The clusters did not differ on genetic variations of the serotonin transporter gene. Conclusions. This study corroborates previous findings suggesting that the Bulimia nervosa diag- nostic category is comprised of three classes of individuals based on co-morbid psychopathology and personality. These differences may have significant etiological and treatment implications.
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symptom fluctuation in eating disorders correlates of diagnostic crossover
American Journal of Psychiatry, 2005Co-Authors: Federica Tozzi, Scott J Crow, Katherine A Halmi, Michael Strober, Allan S Kaplan, Blake D Woodside, Laura M Thornton, Kelly L Klump, Manfred M Fichter, James E MitchellAbstract:Objective: The course of anorexia nervosa often includes the emergence of bulimic symptoms and a crossover to the full syndrome of Bulimia nervosa. However, clinicians’ ability to predict who will develop Bulimia nervosa is limited. The converse phenomenon, crossover from Bulimia nervosa to anorexia nervosa, has not been investigated as thoroughly. The authors identified factors that are associated with crossover from anorexia nervosa to Bulimia nervosa and from Bulimia nervosa to anorexia nervosa. Method: All participants were from the International Price Foundation Genetic Study. Two groups were studied. The first comprised 88 individuals with an initial diagnosis of anorexia nervosa, of whom 32 developed Bulimia nervosa. The second included 350 individuals with Bulimia nervosa, of whom 93 developed anorexia nervosa. Several variables, including DSM-IV axis I and II disorders and personality traits, were evaluated as potential predictors of crossover. Results: For the majority of affected individuals, crossover occurred by the fifth year of illness. A low level of self-directedness was associated with crossover in both directions. Other factors differed by diagnosis: high parental criticism was associated with crossover from anorexia nervosa to Bulimia nervosa, whereas alcohol abuse/dependence and a low level of novelty seeking were associated with crossover from Bulimia nervosa to anorexia nervosa. Conclusions: Low self-directedness may be associated with diagnostic instability in general, whereas other specific factors are related to the direction of diagnostic crossover. These results indicate that personality and family characteristics may influence the course of eating disorders and may be informative for planning interventions.
Pamela K Keel - One of the best experts on this subject based on the ideXlab platform.
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examining weight suppression as a transdiagnostic factor influencing illness trajectory in bulimic eating disorders
Physiology & Behavior, 2019Co-Authors: Pamela K Keel, Lindsay P Bodell, Jean K Forney, Jonathan S Appelbaum, D J L WilliamsAbstract:Abstract Recent research indicates that weight suppression (WS: defined as the difference between highest lifetime and current weight) prospectively predicts illness trajectory across eating disorders characterized by binge eating, including AN binge-purge subtype (ANbp), Bulimia nervosa (BN), and binge eating disorder (BED), collectively referred to as bulimic eating disorders. Through a series of studies, we have developed a model to explain the link between WS and illness trajectory in bulimic eating disorders. Our model posits that WS contributes to reduced circulating leptin, which leads to reduced postprandial glucagon-like peptide 1 (GLP-1) response. Diminished leptin and GLP-1 function contribute to alterations in two reward-related constructs in the Research Domain Criteria (RDoC): reward value/effort and reward satiation. Respectively, these changes increase drive/motivation to consume food and decrease ability for food consumption to lead to a state of satiation/satisfaction. Combined, these alterations increase risk for experiencing large, out-of-control binge-eating episodes. The following review presents evidence that contributed to the development of this model as well as preliminary findings from an on-going project funded to test this model.
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ovarian hormones and binge eating in Bulimia nervosa
Psychological Medicine, 2007Co-Authors: Crystal Edler, Susan F Lipson, Pamela K KeelAbstract:Background. Symptom fluctuation in Bulimia nervosa (BN) is related to menstrual cycle phase. However, the relationship between bulimic symptoms and ovarian hormones (estrogens and pro- gesterone) has not been examined directly in women with BN. Method. Regularly menstruating women with DSM-IV BN (n=9) and regularly menstruating controls (n=8) collected hormone samples and recorded mood and bulimic symptoms daily for 35 consecutive days. Estradiol and progesterone were measured by radioimmunoassay. Within-subject analyses examined prospective longitudinal associations between changes in ovarian hormones and changes in binge frequency in women with BN. Analyses controlled for the possible influence of negative affect on binge frequency as well as the influence of progesterone when examining estradiol associations and the influence of estradiol when examining progesterone associations. Between- subject analyses examined whether women with BN were more likely to have disrupted hormonal profiles than controls. Results. Increases in binge eating were significantly associated with both decreases in estradiol and increases in progesterone in BN women with intact menstrual cycles. Although BN women were more likely to have disrupted hormone profiles than controls, this difference did not reach statistical significance, and mean estradiol and progesterone levels did not differ between bulimic and control groups. Conclusions. The results are consistent with those from experimental animal studies and suggest that decreases in estradiol and increases in progesterone may contribute to increases in binge eating. Ovarian hormone function represents a promising candidate for unraveling the neurobiological mechanisms of binge eating.
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peer influence on bulimic symptoms in college students
Journal of Abnormal Psychology, 2006Co-Authors: Alyson K Zalta, Pamela K KeelAbstract:This longitudinal study examined the influence of peer selection and socialization on bulimic symptoms in college students. Ninety-eight participants completed measures of bulimic symptoms, self-esteem, perfectionism, and impulsivity in the spring and fall of 2003. Peer influence was assessed by examining similarity among selected peers, unselected peers, and nonpeers over time. Among selected peers, bulimic symptoms demonstrated patterns of socialization, self-esteem and perfectionism demonstrated patterns of selection, and these personality traits longitudinally predicted changes in bulimic symptoms. Unselected peers demonstrated no similarity for Bulimia, self-esteem, or perfectionism, but they did evidence socialization for impulsivity. The findings support an etiological model that integrates social and individual risk factors in creating environments that influence disordered eating among college students.
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postremission predictors of relapse in women with eating disorders
American Journal of Psychiatry, 2005Co-Authors: Pamela K Keel, David J Dorer, Debra L Franko, Safia C Jackson, David B HerzogAbstract:OBJECTIVE: The authors sought to evaluate patterns and predictors of relapse among women with eating disorders. METHOD: Interviews were conducted biannually to annually to assess symptoms of eating disorders, axis I disorders, treatment, and psychosocial function on a weekly basis for women diagnosed with anorexia nervosa (N=136) or Bulimia nervosa (N=110) and prospectively followed for 9 years. At the last follow-up, 229 (93%) of the subjects had been retained in the study group. RESULTS: Relapse occurred in 36% of the women with anorexia nervosa and 35% of the women with Bulimia nervosa. Women with intake diagnoses of anorexia nervosa, restricting subtype, tended to develop bulimic symptoms during relapse, whereas women with intake diagnoses of anorexia nervosa, binge-purge subtype, or Bulimia nervosa tended to return to bulimic patterns during relapse. Greater body image disturbance contributed to a risk of relapse in both eating disorders, and worse psychosocial function increased the risk of relapse ...
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symptom fluctuation in Bulimia nervosa relation to menstrual cycle phase and cortisol levels
Psychological Medicine, 2003Co-Authors: Natalie Lester, Pamela K Keel, Susan F LipsonAbstract:Background. Individuals with Bulimia nervosa report significant symptom fluctuation, and some studies have suggested a premenstrual exacerbation of binge frequency. The purpose of this study is to explore the hormonal correlates of symptom fluctuation in Bulimia nervosa.Method. For five consecutive weeks (one full menstrual cycle), eight women with Bulimia nervosa and eight non-eating-disordered control women collected morning saliva samples and recorded several mood characteristics; the bulimic women also recorded binge and purge episodes. Subsequently, salivary cortisol and androgen levels were determined by radioimmunoassay.Results. Bulimic symptoms were exacerbated in both the mid-luteal and premenstrual phases, when compared with the follicular and ovulatory phases (F(3,21)=3·76, P=0·026; contrast analysis t(7)=3·47, P<0·01). Fluctuation in cortisol was closely correlated with fluctuation of bulimic symptoms, with elevated cortisol secretion following symptom exacerbation (r(24)=0·64, P=0·001).Conclusions. Bulimic symptom fluctuation appears to be related to two hormonal phenomena – phase of the menstrual cycle and cortisol secretion – with menstrual-cycle phase influencing bulimic symptom severity, and bulimic symptom severity effecting increases in cortisol secretion. Improved understanding of the hormonal causes and consequences of symptom fluctuation may lead to improved psychological and pharmacological treatments for Bulimia nervosa.
